Hybrid Perventricular Venus P-Valve Implantation Via Mini-Thoracotomy in a Patient With Mechanical Tricuspid Valve

Figures

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  Visual Summary. Hybrid Perventricular Venus P-Valve Implantation via Mini-Thoracotomy in a High-Risk Redo Patient With a Mechanical Tricuspid Prosthesis ASD = atrial septal defect; CPB = cardiopulmonary bypass; CTA = computed tomography angiography; RF = radiofrequency; RV = right ventricle; VSD = ventricular septal defect.

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  Figure 1. Preprocedural CT Evaluation of the RVOT Anatomy Top: 3-dimensional CT reconstructions demonstrating RVOT and pulmonary artery morphology in right anterior oblique, left anterior oblique, and lateral projections. Bottom: Multiplanar CT images illustrating the dilated RVOT, pulmonary annulus, and narrowing at the sinotubular junction. CT = computed tomography; RVOT = right ventricular outflow tract.

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  Figure 2. Hybrid Perventricular Access Via Left Mini-Thoracotomy Intraoperative photographs demonstrating surgical exposure of the right ventricular anterior wall through a left mini-thoracotomy, placement of purse-string sutures on the right ventricle, and direct introduction of the delivery sheath for perventricular valve implantation.

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  Figure 3. Angiographic Assessment of the RVOT and Main Pulmonary Artery During Hybrid Perventricular Access Fluoroscopic images demonstrating contrast injections into the RVOT and main pulmonary artery, performed through the 11-F introducer sheath in the first 2 panels and through a 6-F pigtail catheter advanced through the sheath in the last 2 panels, for pre-implantation anatomical assessment before valve deployment. Abbreviation as in Figure 1.

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  Figure 4. Balloon Interrogation of the RVOT Before Valve Implantation Fluoroscopic images demonstrating balloon sizing of the RVOT during contrast injection, confirming circumferential apposition and suitability for transcatheter valve implantation. (A) Right anterior oblique view, (B) Lateral view. Abbreviation as in Figure 1.

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  Figure 5. Coronary Compression Testing During Balloon Interrogation Fluoroscopic images demonstrating simultaneous coronary angiography during balloon inflation within the right ventricular outflow tract to assess the risk of coronary artery compression before valve implantation. (A) Left anterior oblique (LAO) 40° with 30° caudal cranial/caudal tilt, (B) Lateral view.

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  Figure 6. Sequential Fluoroscopic Steps of Venus P-Valve Implantation Fluoroscopic images demonstrating the stepwise deployment of the Venus P-Valve: (A) advancement of the Braidin Pro delivery sheath into the right ventricular outflow tract; (B) positioning of the delivery sheath within the right pulmonary artery; (C-F) expansion of the distal and proximal flares; and (G, H) final positioning of the valve within the right ventricular outflow tract and main pulmonary artery.

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  Figure 7. Postimplantation Angiographic Assessment After Venus P-Valve Deployment Fluoroscopic images demonstrating contrast injections following Venus P-Valve implantation, confirming stable valve position within the right ventricular outflow tract and main pulmonary artery, with no residual pulmonary regurgitation or evidence of obstruction. (A) Right anterior oblique view, (B) Lateral view, (C) Posteroanterior view.